Earl St Physiotherapy 6 Week Walking Challenge 2025

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27th October - 7th December 2025

Ph: (08) 9881 3799

Email: earlstphysio@gmail.com

Raising funds for The Fiona Wood Foundation

Email *

Full Name *

Mobile Number *

Date of Birth *

YYYY

Town *

What is your reason for joining? *

Increase steps

Lose Weight

Raise Money for The Fiona Wood Foundation

Fun

Community Group Walking

Mental Wellbeing

Social

Other:

Registration Fees - Please select one:
*

Registration Fee $30

Registration Fee + T Shirt $65

Additional T Shirt $40 each

Required

Shirt Size (S, M, L, XL)

Please note there are a limited number of shirts, sizes will be allocated on a first come, first serve basis. If we are unable to provide you with a suitable shirt we can arrange a refund.

How did you hear about the challenge? *

Would you like to add an additional donation to The Fiona Wood Foundation?

$10

$20

$50

Other:

Clear selection

Payment options Select 1 Only

Only select cash or square payment if you have completed payment in person. Select bank payment if you are yet to pay, or click the link to use the payment portal via Square.

*Please note- Square charges over 2% in fees; please consider adding a small donation to cover this ( eg. $30 fees are $0.75, $65 fees are $1.65 ).

Payment Link: https://square.link/u/l8oR7oqv (REMEMBER TO FINISH SIGNING UP AFTER PAYMENT)

Bank Transfer (BSB: 086 852 ACC: 250124460 Acc Name: Melissa Tinker, please use name as reference)

Cash

Square payment (Narrogin Show only)

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